Evaluation of the Esmark Bandage as a Tourniquet for Forefoot Surgery

Abstract

Purpose: Although used routinely as a tourniquet in forefoot surgery, the pressure under an Esmark bandage has had little evaluation, and its use has been discouraged by some. The purpose of this study was to quantitate the pressure generated by an elastic bandage in a clinical setting and compare several different types of commercially available Esmark bandages. Methods: Five foot and ankle fellowship program directors and five foot and ankle fellowship trained surgeons comprised the volunteer group which performed clinical simulations with a 6-inch Esmark bandage at the ankle level. Variables were then added, including different padding, a change in the position of the surgeon, and a 4-inch Esmark bandage. A questionnaire on their use of an elastic bandage in practice was also administered. Differences in pressure between different types of available 6-inch Esmark bandages were also compared. Pressure measurements were recorded by a pressure monitor device. Results: The average pressure of the 10 surgeons' trials for three wraps with a tuck was 222 mm Hg (range, 146–319 mm Hg); four wraps with a tuck averaged 288 mm Hg (range, 202–405 mm Hg). No significant difference was seen between the standard technique and when the surgeon stood (three wraps and a tuck, p = .26; four wraps and a tuck, p = .33), when cast padding was used (three wraps and a tuck, p = .62; four wraps and a tuck, p = .74), or a 4-inch Esmark bandage (three wraps and a tuck, p >.99; four wraps and a tuck, p = .34). There was a significant decrease in the pressure when a blue towel was used as padding (three wraps and a tuck, p = .05; four wraps and a tuck, p = .04). Pressures obtained by the 10 different volunteers were uniform with little variation (three wraps and a tuck = 222 ± 61 mm Hg; four wraps and a tuck = 288 ± 68 mm Hg). No significant difference was seen between the different types of 6-inch Esmark bandages ( p > .05). The combined complication rate for the 10 surgeons is estimated to be less than 0.1%. Conclusion: The practice of using a 6-inch Esmark bandage as a tourniquet at the ankle level for forefoot procedures is a safe and reliable method. Although pressures between surgeons vary, the average pressure is in an effective yet safe range. Recommendations for the application of the Esmark bandage as a tourniquet are given.